[show abstract][hide abstract] ABSTRACT: Objective. Velopharyngeal insufficiency (VPI) occurs frequently in cleft palate patients. VPI also occurs in patients without cleft palate, but little is known about this patient population and this presents a diagnostic dilemma. Our goal is to review the etiology of noncleft VPI and the surgical treatment involved. Design/Patients. A retrospective review of VPI patients from 1990 to 2005. Demographic, genetic, speech, and surgical data were collected. We compared the need for surgery and outcomes data between noncleft and cleft VPI patients using a Student's t-test. Results. We identified 43 patients with noncleft VPI, of which 24 were females and 19 were males. The average age at presentation of noncleft VPI was 9.6 years (range 4.5-21). The average patient age at the time of study was 13.4 years. The etiology of VPI in these noncleft patients was neurologic dysfunction 44%, syndrome-associated 35%, postadenotonsillectomy 7%, and multiple causes 14%. The need for surgical intervention in the noncleft VPI group was 37% (15/43) compared to the cleft palate controls, which was 27% (12/43). There was not a statistical difference between these two groups (P > 0.5). Conclusion. Noncleft VPI often occurs in patients who have underlying neurologic disorders or have syndromes. The rate of speech surgery to address VPI is similar to that of cleft palate patients. We propose that newly diagnosed noncleft VPI patients should undergo a thorough neurologic and genetic evaluation prior to surgery.
International Journal of Otolaryngology 01/2012; 2012:296073.
[show abstract][hide abstract] ABSTRACT: Children born with Pierre-Robin Sequence (PRS) have cleft palate, micrognathia, and macroglossia. After the repair of the cleft palate, velopharyngeal insufficiency (VPI) can occur in a subset of patients. We hypothesize that the need for the surgical correction of VPI in PRS children is no different than cleft palate only (CPO) patients.
A retrospective study of 21 children with non-syndromic PRS who were matched to 42 non-syndromic, CPO controls for age and sex. We reviewed incidence of VPI, the need for secondary speech surgery, and speech outcomes post-operatively.
Secondary surgery to correct VPI was necessary in 3 of 21 (14.29%) PRS patients (2 Pharyngeal Flaps, 1 Z-plasty), vs. 10 of 42 (23.81%) CPO (9 Pharyngeal Flaps, 1 Z-plasty) controls. Mean age for VPI surgery for PRS vs. controls: 5.33 vs. 6.41 years, respectively. For final speech outcomes, 73.68% of PRS vs. 71.88% of controls showed no evidence of hypernasality, 89.47% of PRS patients vs. 93.75% of controls showed no evidence of hyponasality, and 76.47% of PRS patients vs. 78.13% of controls had normal velopharyngeal competence (p>0.90 for all three measures).
Our findings suggest that children born with a Pierre-Robin Sequence do not have a higher rate of post-operative VPI after cleft palate repair and are no more likely to require additional surgical intervention.
International journal of pediatric otorhinolaryngology 07/2011; 75(10):1252-4. · 0.85 Impact Factor
[show abstract][hide abstract] ABSTRACT: The purpose of this study is to evaluate quantitative structural measures of the ventromedial prefrontal cortex (vmPFC) in boys with isolated clefts of the lip and/or palate (ICLP) relative to a comparison group and to associate measures of brain structure with quantitative measures of hyperactivity, impulsivity, and inattentiveness. A total of 50 boys with ICLP were compared to 60 healthy boys without clefts. Magnetic resonance imaging brain scans were used to evaluate vmPFC structure. Parents and teachers provided quantitative measures of hyperactivity, impulsivity, and inattentiveness using the Pediatric Behavior Scale. Boys with ICLP had significantly higher ratings of hyperactivity/impulsivity/inattention (HII) and significantly increased volume of the right vmPFC relative to the comparison group. There was a direct relationship between HII score and vmPFC volume in both the ICLP group and control group, but the relationship was in the opposite direction: in ICLP, the higher the vmPFC volume, the higher the HII score; for the comparison group, the lower the vmPFC volume, the greater the HII score. The vmPFC is a region of the brain that governs behaviors of hyperactivity, impulsivity and inattention (HII). In boys with ICLP, there are higher levels of HII compared to the controls and this is directly related to a significantly enlarged volume of the right vmPFC. Enlargement of this region of the brain is therefore considered to be pathological in the ICLP group and supports the notion that abnormal brain structure (from abnormal brain development) is the underlying etiology for the abnormal behaviors seen in this population.
Journal of Neurodevelopmental Disorders 12/2010; 2(4):235-42. · 3.45 Impact Factor
[show abstract][hide abstract] ABSTRACT: Van der Woude syndrome (VWS; OMIM 119300) is an autosomal-dominant condition associated with clefts of the lip and/or palate and lower lip pits and is caused by mutations in interferon regulatory factor 6 (IRF6). The standard of practice for children born with cleft lip/palate is surgical repair, which requires proper wound healing. We tested the hypothesis that children with VWS are more likely to have wound complications after cleft repair than children with nonsyndromic cleft lip/palate (NSCLP). Furthermore, we hypothesized that children with VWS have more surgical procedures. A retrospective, case-controlled study was performed. Seventeen children with VWS and 68 matched controls with NSCLP were scored for the presence of wound complications after cleft repair, for the severity of complications, and for number of surgeries from age 0 to 10. Of the 17 children with VWS, 8 had wound complications. Of 68 controls, 13 had wound complications (P = 0.02). Of 8 wound complications in the VWS group, 6 were major, whereas of 13 complications in the control group, 9 were major (P = 0.04). Most wound complications were fistulae and occurred in isolated cleft palate and bilateral cleft lip. The mean number of surgeries in the VWS group was 3.0 compared with 2.8 in the control group (P = 0.67). Our studies suggest that children with VWS have an increased risk for wound complications after cleft repair compared with children with NSCLP. Furthermore, these data support a role for IRF6 in wound healing.
The Journal of craniofacial surgery 09/2010; 21(5):1350-3. · 0.81 Impact Factor
[show abstract][hide abstract] ABSTRACT: To evaluate potential abnormalities in brain structure of children and adolescents with unilateral clefts.
Tertiary care center.
Boys aged 7 to 17 years with right (n=14) and left (n=19) clefts were compared with healthy age-matched boys (n=57).
Structural brain measures were obtained using magnetic resonance imaging.
It was explored whether laterality of clefts had a significant effect on brain structure. To this end, volumes of tissue types and various brain regions were evaluated.
Total white matter was significantly lower in boys with right clefts compared with boys with left clefts and healthy boys. Gross regional analyses demonstrated that reductions in white matter were evident in both the cerebellum and the cerebrum in boys with right clefts. Furthermore, within the cerebrum, white matter volumes were particularly low in the frontal lobes and the occipital lobes.
These preliminary results suggest that right clefts may be associated with more abnormalities in brain structure. More generally, laterality of a birth defect may have a significant effect on a developing organism.
Archives of pediatrics & adolescent medicine 08/2010; 164(8):763-8. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Abstract Objective: To identify regional cerebellar structural differences in boys and girls with nonsyndromic cleft of the lip and/or palate and determine whether these differences are related to speech impairment. Design: Between 2003 and 2007, measures on cerebellar volume were obtained on 43 children with nonsyndromic cleft of the lip and/or palate and 43 age- and sex-matched, healthy controls. Children with the cleft condition also received speech evaluations. Children with nonsyndromic cleft of the lip and/or palate were recruited from clinic records, and controls (screened for medical, psychiatric, speech/language, and behavioral concerns) were recruited from the local community. All tests were administered at a large midwestern hospital. Boys and girls with nonsyndromic cleft of the lip and/or palate were compared with the healthy controls on global and regional measures of cerebellar volume. Areas of significant difference were then correlated with measures of speech to assess relationships in children with nonsyndromic cleft of the lip and/or palate. Results: Boys with nonsyndromic cleft of the lip and/or palate had smaller cerebellums than controls (p = .002); whereas, for girls, only regional reductions in size reached significance (corpus medullare, p = .040). Cerebellum size was correlated with articulation for boys (p = .045). Conclusions: These findings lend support to previous research documenting abnormal brain structure in children with nonsyndromic cleft of the lip and/or palate and suggest that the cerebellum may play a role in speech deficits along with other structural causes, at least in boys.
The Cleft Palate-Craniofacial Journal 02/2010; 47(5):469-75. · 1.24 Impact Factor
[show abstract][hide abstract] ABSTRACT: During cleft palate repair, levator sling palatoplasty with tensor veli palatini tendon transection significantly improves speech results. However, the procedure may pose a risk to eustachian tube function. This study assesses the impact of three types of palatoplasty techniques on eustachian tube function: no tensor transection, tensor transection alone, and a new addition to the palatoplasty technique, tensor tenopexy.
A retrospective review was conducted of all patients undergoing cleft palate repair at two institutions between 1997 and 2001. Three cleft palate repair groups were studied: no tensor transection (n = 64), tensor transection alone (n = 31), and tensor tenopexy (n = 52). The percentages of patients requiring myringotomy tubes at each year of age were compared among the three groups.
By 7 years of age, there was a significantly decreased need for myringotomy tubes in patients who underwent no tensor transection compared with patients who underwent tensor transection alone (38 percent versus 61 percent, respectively; p = 0.05), as well as for patients who underwent tensor tenopexy compared with patients who underwent tensor veli palatini tendon transection (23 percent versus 61 percent, respectively; p < 0.001). Also, by the age of 7, there was a trend toward a decreased need for myringotomy tubes in patients who underwent tensor tenopexy compared with patients who underwent no tensor transection (23 percent versus 38 percent, respectively; p = 0.11).
No tensor transection and tensor tenopexy significantly decrease the need for myringotomy tubes compared with tensor transection alone. There is a small decrease in the need for myringotomy tubes when comparing tensor tenopexy with no tensor transection.
Plastic and reconstructive surgery 01/2010; 125(1):282-9. · 2.74 Impact Factor
[show abstract][hide abstract] ABSTRACT: Introduction: Cleft lip and palate deformities are one of the most common birth defects. The alveolar cleft requires bony repair to allow proper eruption of dentition. The purpose of this study is to evaluate success in the repair of alveolar clefts and examine whether the addition of allogenic materials improves outcomes. Materials and Methods: One hundred three patients with cleft lip and palate were identified retrospectively after institutional review board approval was obtained. The authors reviewed their medical records, surgical complication rate, need for revision surgery, and whether allogenic materials were used. The data were then compared using analysis of variance. Results: The average patient age was 16.6 years (range, 7 to 25 years). There were 59% unilateral clefts and 41% bilateral clefts identified. The average age at palate repair was 17.5 months. The average age at alveolar bone grafting (ABG) was 8.9 years (range, 5 to 15 years). Allogenic material was used in 22 primary ABGs and 10 revision ABGs. The revision rate of unilateral ABGs was 18%, which was statistically different from the 32% revision rate of bilateral ABGs. The use of allogenic material during ABG repair did not affect the revision rate. Conclusion: Secondary alveolar bone grafting is necessary for complete rehabilitation of the cleft alveolus. The patients undergoing ABG had an overall 23% revision rate, 18% for unilateral and 32% for bilateral clefts. The use of allogenic materials during ABG did not show a statistical benefit in this study, but future review including more patients may be useful.
The Cleft Palate-Craniofacial Journal 05/2009; 46(6):610-2. · 1.24 Impact Factor
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to assess neurological soft signs in children and adolescents with isolated cleft of the lip or palate (iCL/P) compared with healthy controls. Children with iCL/P were recruited through the university cleft clinic. Control subjects were recruited through advertisements. Of the 166 subjects who participated (age range 7 to 17 years, M = 12.5, SD = 3.2), 77 had iCL/P (48 male) and 89 were healthy controls (44 male). All participants took the Physical and Neurological Examination of Subtle Signs and selected tests of motor coordination. A multivariate analysis of variance assessed differences between subjects with and without iCL/P. Also, a Pearson correlation estimated the relationship between the neurological soft signs and age. Subjects with iCL/P scored significantly higher on all neurological soft signs variables. These higher scores were associated with younger age. Findings lend support to the hypothesis of aberrant brain development in children with iCL/P.
Perceptual and Motor Skills 03/2008; 106(1):197-206. · 0.49 Impact Factor
[show abstract][hide abstract] ABSTRACT: Nonsyndromic clefts of the lip and/or palate are common birth defects with a strong genetic component. Based on unequal gender ratios for clefting phenotypes, evidence for linkage to the X chromosome and the occurrence of several X-linked clefting syndromes, we investigated the role of skewed X chromosome inactivation (XCI) in orofacial clefts. Our samples consisted of female monozygotic (MZ) twins (n = 8) and sister pairs (n = 152) discordant for nonsyndromic clefting. We measured the XCI pattern in peripheral blood lymphocyte DNA using a methylation based androgen receptor gene assay. Skewing of XCI was defined as the deviation in inactivation pattern from a 50:50 ratio. Our analysis revealed no significant difference in the degree of skewing between twin pairs (P = 0.3). However, borderline significant differences were observed in the sister pairs (P = 0.02), with the cleft lip with cleft palate group showing the most significant result (P = 0.01). We did not find evidence for involvement of skewed XCI in the discordance for clefting in our sample of female MZ twins. However, results from the paired sister study suggest the potential contribution of skewed XCI to orofacial clefting, particularly cleft lip and palate.
American Journal of Medical Genetics Part A 01/2008; 143A(24):3267-72. · 2.30 Impact Factor
[show abstract][hide abstract] ABSTRACT: To review the clinical outcome for patients with Van der Woude syndrome undergoing surgical excision of congenital lip sinuses.
Retrospective chart review.
Multidisciplinary cleft-craniofacial team within a tertiary care hospital.
Seventeen patients with Van der Woude syndrome were identified from hospital records as having cleft lip and/or palate surgery performed at the University of Iowa, and six of these patients underwent simple surgical excision of lower lip sinuses. Main
Incidence of postoperative complications and number of surgeries required per patient for correction of lower lip defect.
All six patients undergoing surgical excision of lip sinuses had postoperative mucocele formation. These uniformly required one or two further surgeries for correction. There were no other complications associated with the procedures and no patient had a pre- or postoperative whistling deformity. Cosmetic outcome was thought to be satisfactory in all cases.
Despite the overall improvement in cosmetic appearance following simple surgical excision of congenital lower lip sinuses, the high rate of mucocele formation and repeat surgery has led to cautious preoperative counseling regarding the risks and benefits of the procedure.
The Cleft Palate-Craniofacial Journal 10/2007; 44(5):555-7. · 1.24 Impact Factor
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to evaluate the factors that affect the health-related quality of life of preadolescent children with nonsyndromic oral clefts using the Pediatric Quality of Life Inventory instrument and to evaluate whether there were any differences related to the type of cleft or other factors.
Data for this study were derived from telephone interviews with the parents of a statewide population of children who were in the Iowa Registry for Congenital and Inherited Disorders, were aged 2 to 12 years, had nonsyndromic oral clefts, and were born in Iowa between January 1, 1990, and December 31, 2000. Twenty-minute interviews were conducted with mothers of 104 children in the spring and summer of 2003; respondents then completed and mailed back Pediatric Quality of Life Inventory surveys 2 to 3 weeks after the interviews (69% participation rate).
After controlling for demographic characteristics, children with less severe speech problems had higher total Pediatric Quality of Life Inventory scores as well as higher physical and psychosocial health domain scores. Age and cleft type interacted, with younger children (aged 2-7 years) with a cleft lip or cleft lip and palate having higher health-related quality of life scores than children with an isolated cleft palate; however, this pattern was reversed for older children (aged 8-12 years).
Speech and aesthetic concerns seem to have been important factors affecting the health-related quality of life for children with oral clefts. These factors seem to be more important as children get closer to adolescence (ages 8-12 years) when acceptance by peers becomes more critical.
[show abstract][hide abstract] ABSTRACT: Isolated clefts of the lip and/or palate (ICLP) are developmental craniofacial abnormalities that have consistently been linked to increased social inhibition or shyness. Two explanations have been proposed: (1) psychosocial factors related to differences in facial appearance may lead to low self-concept and subsequent shyness, or (2) abnormal development of brain structures involved in social function, such as the ventral frontal cortex (VFC), may underlie the difference. To investigate these two possibilities this study was designed to evaluate measures of social function in relation to measures of self-concept and VFC morphology. Subjects included 30 boys (age 7-12) with ICLP and a comparison group of 43 boys without cleft in the same age category. Social function and self-concept were assessed using questionnaires with standardized scoring filled out by subjects and one of their parents. The cortical volume and surface area of the VFC, composed of the orbitofrontal cortex (OFC) and straight gyrus (SG), were evaluated using structural magnetic resonance imaging. The ICLP subjects had significantly impaired social function relative to the comparison group. No difference in self-concept was identified. VFC morphology revealed significant differences between groups, particularly decreased volume and surface area in the left SG of the ICLP group. Moreover, abnormal VFC measures were correlated with social dysfunction but measures of self-concept were not. These results are consistent with the possibility that aberrant VFC development may partially underlie social dysfunction in boys with ICLP.
Behavioural Brain Research 09/2007; 181(2):224-31. · 3.33 Impact Factor
[show abstract][hide abstract] ABSTRACT: To evaluate brain structure in a sample of children with isolated clefts of the lip and/or palate (ICLP).
Tertiary care center.
A large sample of 74 children aged 7 to 17 years with ICLP was compared with a healthy control group, matched by age and sex.
Isolated cleft lip and/or palate.
General measures of height and head circumference were obtained. Brain structure was evaluated using magnetic resonance imaging, generating both general and regional brain measures (volumes).
Height was significantly lower in the ICLP group (F = 4.83, P = .03). After controlling for this smaller body size, children with ICLP had abnormally small brains with both cerebrum (F = 4.47, P = .04) and cerebellum (F = 14.56, P <.001) volumes substantially decreased. Within the cerebrum, the frontal lobe was preferentially decreased (F = 7.22, P = .008) and subcortical nuclei were also substantially smaller (F = 4.18, P = .003). Tissue distribution of cortical gray matter and white matter within the cerebrum were abnormal in boys with ICLP (larger cortical volume, smaller volume of white matter) but proportional to controls in girls with ICLP.
Children with ICLP have abnormal brain structure, potentially due to abnormal brain development. The fact that the pattern of brain abnormalities in children with ICLP is dramatically different from the pattern of brain abnormalities seen in adults with ICLP suggests that brain growth and development trajectory is also abnormal in subjects with ICLP.
Archives of Pediatrics and Adolescent Medicine 08/2007; 161(8):753-8. · 4.28 Impact Factor
[show abstract][hide abstract] ABSTRACT: To evaluate the outcomes of care for children by type of oral cleft.
Data were collected through structured telephone interviews during 2003 in Iowa with mothers of 2- to 12-year-old children with oral clefts. Interviews with mothers of children with clubfoot and statewide data on Iowa children were used for comparison.
Participants included mothers of children in Iowa born between 1990 and 2000 with nonsyndromic oral clefts. Children were identified by the statewide Iowa Registry for Congenital and Inherited Disorders.
Rating of cleft care, severity of condition, health status, esthetic outcome, speech, and school performance were evaluated by type of oral cleft.
Children with cleft lip and palate were most likely to have their clefts rated as very severe. Children with palatal involvement were reported to have a lower health status and were almost twice as likely to be identified as having a special health care need compared with either children with cleft lip or children statewide. Children with cleft lip had more esthetic concerns; children with palatal involvement had the most speech concerns.
Although mothers generally believed their children had received high-quality care, ratings of the children's current health status and outcomes of care varied significantly by type of cleft (cleft lip, cleft palate, and cleft lip and palate). Differences observed in this population-based study support the proposition that cleft type should be considered when examining outcomes of care for children with oral clefts.
The Cleft Palate-Craniofacial Journal 12/2006; 43(6):715-21. · 1.24 Impact Factor
[show abstract][hide abstract] ABSTRACT: In a previous study from our lab, adult males with non-syndromic cleft lip and/or palate (NSCLP) were shown to have significantly lower temporal lobe gray matter volume than matched controls. The current study was designed to begin a regional analysis of specific subregions of the temporal lobe. The superior temporal plane (STP) is a brain region involved in the governance of auditory processing and aspects of language. The cognitive deficit of subjects with NSCLP is characterized by specific deficits in language; therefore this region of the temporal lobe is particularly important to investigate in this population. The STP has been found to be structurally abnormal in subjects with dyslexia, another developmental disorder involving language deficit. The hypothesis for the current study was that the STP in subjects with NSCLP would be structurally abnormal and that the abnormality would be related to cognitive deficit, but not to developmental hearing deficit.
Manual tracing of the STP in NSCLP males and matched controls was performed on magnetic resonance imaging (MRI) scans. Ratios of STP to total temporal lobe gray matter volume were calculated and compared across groups. In addition, the morphology of the STP was correlated to cognitive function as well as measures of hearing deficit during infancy and childhood.
Despite overall deficit in temporal lobe gray matter, the STP is disproportionately large in subjects with NSCLP compared to controls. Further, gray matter volume of the STP was inversely correlated with IQ and language test scores in CLP subjects. Hearing loss throughout childhood and adulthood was not significantly correlated with brain morphology.
The structure of the superior temporal plane in adult males with NSCLP was disproportionately large. This abnormally increased volume was directly related to IQ, with greater STP volume being associated with lower cognitive functioning, thus characterizing the finding as 'pathologic enlargement'. Moreover, there was no relationship between the structure of the STP and measures of childhood hearing impairment, supporting the notion that the language deficits of this population are more likely due to abnormal brain development than to the effects of hearing deficit during childhood.
Journal of Child Psychology and Psychiatry 11/2006; 47(10):994-1002. · 5.42 Impact Factor
[show abstract][hide abstract] ABSTRACT: Assess incidence of conductive hearing loss, ear pathology, and associated communicative disorders in cleft palate patients.
Retrospective chart review of 101 patients all treated at a tertiary facility since birth.
The median patient age was 19 years old (range 8-25) at last follow-up, 35% female. Median age of cleft palate repair was 16 months (range 12-60). Median number of myringotomy tubes was 3 (range 1-7). Conductive hearing loss (CHL) greater than 20 db PTA was found in 25% of patients at last follow-up. Severity of CHL was mild in 75%, moderate in 21%, and severe in 4%. Cholesteatoma was identified in 5.9%. The mean age at resolution of CHL was 5 years (range 3-19). Risk factors associated with CHL at last follow-up included middle ear surgery (P = 0.016), cholesteatoma (P = 0.003), and 4 or more myringotomy tube insertions (P = 0.030). Associations between CHL and age at cleft repair, speech impairment, or learning disabilities were not found.
Children requiring increased number of myringotomy tubes and middle ear surgery and found to have cholesteatoma are at increased risk for long-standing CHL. EBM rating: C-4
Cleft palate children requiring multiple tube insertions should be monitored closely for CHL.
Otolaryngology Head and Neck Surgery 07/2006; 134(6):946-8. · 1.63 Impact Factor
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to test the hypothesis that no significant difference exists in the speech outcomes between patients with severe velopharyngeal incompetence (VPI) who receive a pharyngeal flap and patients with less severe VPI who receive a Z-plasty for management of VPI.
This retrospective study from 1993 to 2002 included a review of pre- and postoperative perceptual speech and resonance assessments of patients with marginal VPI who received a Furlow double-opposing Z-plasty and patients with VPI who received a pharyngeal flap.
All patients had surgical management of VPI at the Cleft Palate-Craniofacial Clinic at University of Iowa Hospitals and Clinics.
Both groups benefited from surgery with significant reduction in perceived hypernasality (p < .001). Comparison of postoperative assessments indicated no difference between the groups in hypernasality or hyponasality ratings. Neither group had a significant increase in hyponasality.
Both pharyngeal flap and double-opposing Z-plasty proved equally effective at reducing hypernasality when the selection of the surgical procedures was based on preoperative ratings of perceived hypernasality and evaluation of velopharyngeal physiology. Severity of the VPI is an important factor when considering surgical management of VPI. Thorough preoperative evaluations of patients with VPI are essential in appropriate treatment planning.
The Cleft Palate-Craniofacial Journal 01/2006; 43(1):38-43. · 1.24 Impact Factor
[show abstract][hide abstract] ABSTRACT: An interactive web-based system was designed to facilitate communication between nonspecialist speech pathologists who provide therapy for individuals with speech disorders associated with cleft palate or craniofacial anomalies and specialist speech pathologists who provide physiologically based assessments of speech production. The web site includes instructional presentations, streaming video clips of endoscopic examinations, and exchange of information about the nature of therapy as recommended by the specialist and as provided by the nonspecialist. The approach demonstrates use of web-based computer facilities to improve the quality of communication among professionals with the goal of improving the outcomes of speech therapy. Information from the site can also be used in academic training programs as a teaching tool in courses on cleft palate speech.
The Cleft Palate-Craniofacial Journal 12/2005; 42(6):585-8. · 1.24 Impact Factor
[show abstract][hide abstract] ABSTRACT: In a previous magnetic resonance imaging (MRI) study, men with nonsyndromic clefts of the lip and/or palate (NSCLP) were found to have abnormalities in the structure of the frontal lobe of the brain. Moreover, many subjects with nonsyndromic clefts of the lip and/or palate have been described as being socially inhibited. A subregion of the frontal lobe, the ventral frontal cortex (VFC), has been shown to be related to social function. This study was designed to evaluate the morphology of the ventral frontal cortex in men with nonsyndromic clefts of the lip and/or palate, and the morphology's relationship to social function.
Subjects were 46 men with nonsyndromic clefts of the lip and/or palate and 46 sex matched controls. Social function was assessed using a standardized scale. The morphology of the ventral frontal cortex (composed of the orbitofrontal cortex [OFC] and the straight gyrus [SG]) was obtained from magnetic resonance imaging scans using the software BRAINS.
After controlling for frontal lobe gray matter, the patient group had significant reductions in orbitofrontal cortex volume and area. The straight gyrus was not morphologically abnormal. Measures of orbitofrontal cortex morphology were significantly correlated to measures of social function--the greater the structural abnormality, the greater the social dysfunction.
Compared with healthy controls, subjects with nonsyndromic clefts of the lip and/or palate showed morphologic abnormalities in the cortical surface anatomy of a brain region known to govern social function, the orbitofrontal cortex. Moreover, the structural abnormality in this brain region was directly correlated with social function.
The Cleft Palate-Craniofacial Journal 04/2005; 42(2):138-44. · 1.24 Impact Factor